1016例IgA肾病患者中医证候的多中心流行病学调查及相关因素分析

A Multi-centeric Epidemiological Survey on TCM Syndrome in 1016 Patients with IgA Nephropathy and Analysis of Its Relevant Factors

目的对IgA肾病的中医证候分布规律及与主要预后指标的关系进行调查,为中西医结合诊治本病的规范化提供依据。方法采用多中心流行病学现场调查的方法,收集了1016例IgA肾病患者的人口学、中医证候学及实验室检查资料,探索IgA肾病中医证候的分布规律。结果出现概率在10%以上的中医症状包括阴虚、气虚、阳虚、湿热及血瘀症状;其中气阴两虚证最多(41·4%),脾肾阳虚证最少(8.1%);随着年龄的增长,脾肺气虚证患者比例下降,而脾肾阳虚证患者比例上升;兼证中湿热(31·6%)和血瘀(28·9%)最为常见。脾肺气虚、气阴两虚和肝肾阴虚证24h尿蛋白定量、血肌酐、尿素氮显著低于脾肾阳虚证(P<0·05);脾肺气虚、气阴两虚证血压水平显著低于肝肾阴虚证和脾肾阳虚证(P<0·05)。结论气虚、阴虚是IgA肾病的主要临床表现,中医证型与尿蛋白、高血压、肾功能损害等预后指标密切相关。

Objective To investigate the distribution pattern of TCM syndrome in patients with IgA nephropathy and its relationship with the main clinical prognostic indexes to provide a basis for the standardization of integrative medicine in diagnosis and treatment of IgA nephropathy. Methods Muhi-centeric epidemiological field survey was adopted to collect the materials of 1016 IgA nephropathic patients, including demography, TCM syndrome and laboratory findings, for exploring the distribution pattern of TCM syndrome of IgA nephropathy patients. Results Probability of over 10% could be found in the TCM syndromes as yin deficiency, qi deficiency, yang deficiency, damp-heat and blood stasis syndrome, the highest （41.5 % ） was found in qiyin deficiency syndrome and the lowest （8.1% ） in yang deficiency of Pi and Shen. Along with the increasing of age, the percentage of patients with Pi-Fei qi asthenia syndrome descended while those with Pi-Shen yang asthenia ascended. In the accompanying syndromes, damp-heat syndrome and blood stasis syndrome, with the proportion of 32.6% and 28.9% respectively, were the most frequently encountered. The levels of 24 h urinary protein, serum creatinine and urea nitrogen in patients with Pi-Fei qi asthenia syndrome, qi-yin deficiency syn- drorne and Gan-Shen yin asthenia syndrome were significantly lower than those in patients with Pi Shen yang asthenia syndrome, respectively （P 〈 0.05）, while the blood pressure in patients with Pi-Fei qi asthenia syndrome, and qi-yin deficiency syndrome were significantly lower than that in patients with Gan-Shen yin asthenia syndrome and Pi-Shen yang asthenia syndrome （P〈0.01）. Conclusion QLasthenia and yin deficiency is the principal clinical manifestation of IgA nephropathy. TCM syndrome types are closely related with the prognosticindexes as urine protein, hypertension, renal lesion, etc.